摘要:
To study and research the correlation between N-terminal pro-B-type natriuretic peptide and hemo-dynamic variables after percutaneous balloon mitral valvuloplasty. Methods Fifty eight patients of rheumatic mitral stenosis treated by percutaneous balloon mitral valvuloplasty (PBMV) were included in this study. Plasma NT-proBNP concentrations were measured by the RELIA-H NT-proBNP Test in all patients before, immediately and at 1 hour, 2 hours and 24 hours after PBMV. At the same time, pulmonary capillary wedge pressures (PCWP) were measured with Swan-Canz catheter, and other hemodynamic parameters, such as mitral valve areas, left atrial diameters and left ventricle ejection fractions were measured by HP ultrasound cardiogram. The relations between NT-proBNP concentrations and PCWP and other hemodynamic parameters were studied. Results MLAPs immediately after PBMV were significantly higher than those before PBMV ([34.61 ± 4.02]mmHg: [ 14. 96 ± 3. 88 ] mmHg ,P 0.05; r = 0.036, P>0.05, respectively) There was a positive correlation between changes in plasma NT-proBNP (△NT-proBNP) at 2 hours after PBMV and changes in mean pulmonary capillary wedge pressures (△PCWP) ( r = 0. 68, P<0.01). Conclusion These results indicate that the higer NT-proBNP level is associated with the higher left atrial pressure and higher PCWP in mitral stenosis patients. NT-proBNP may be a significant marker to reflect changes in left atria function after PBMV.%目的 研究经皮二尖瓣球囊扩张术(PBMV)后患者氨基末端B型利钠肽前体(NT-proBNP)与血流动力学变化的关系.方法 采用快速NT-proBNP试验法检测58例成功施行PBMV的风湿性二尖衅狭窄患者术前及术后1h、2h、24h血浆NT-proBNP浓度变化,术前及术后即刻测平均左房压(MLAP),同时行Swan-Ganz漂浮导管,测定肺毛细血管楔压(PCWP),彩色多普勒超声诊断仪测定二尖瓣口面积(MVA)和左房内径(LAD)及左室射血分数(LVEF).将患者血浆NT-proBNP浓度与PCWP等血流动力学参数作相关分析.结果 术后即刻测MLAP较术前比较差异有统计学意义([34.61±4.02] mmHg:[14.96±3.88]mmHg);术后24hLAD和MVA与术前比较P<0.01(术前分别为:[46.92±5.69]mm,[0.98±0.22]cm2,术后24h分别为:[41.24±7.32]mm,[1.43±0.30]cm2);术前和术后LVEF变化P=0.156(术前为[35.3±4.3]%,术后为[36.7±2.6]%);术后1h、2h、24h血浆NT-proBNP浓度变化、PCWP变化和术前比较有统计学意义(P<0.01);相关性分析显示,术后24h的NT-proBNP变化(ΔNT- proBNP)与MLAP变化(ΔMLAP)呈显著正相关(r=0.37,P<0.05);术后24h的NT-proBNP变化(ΔNT-proBNP)与MVA的扩大值(ΔMVA)及LAD的变化(ΔLAD)无相关性(分别为r =-0.047,P>0.05;r =0.036,P>0.05).术后2h,NT-proBNP变化(ΔNT-proBNP)与PCWP变化(ΔPCWP)呈显著正相关(r=0.68,P<0.01).结论 风湿性二尖瓣狭窄患者血浆NT-proBNP水平的升高和左房压,PCWP升高显著相关.NT-proBNP水平对反映PBMV术后左房功能有重要意义.